Encourage breast self-exams everyday, not just in October

Autumn has arrived and that means much of the country is in painted in beautiful shades of orange, gold, red and pink. Wait. Pink?

October is National Breast Cancer Awareness Month, so every organization from major retailers to the NFL is thinking pink. It seems the October issues of every magazine geared toward women are focused on breast cancer detection, treatment and prevention. 

Fundraising events for breast cancer research abound in October — everyone seems to be running, cutting hair or dancing “for a cure.” Many organizations offer free mammograms and clinical breast exams during the month, often set up at shopping centers. There are even roaming vans that are fully loaded with mammography equipment, ready to serve women who might not otherwise have access to screening.

According to the National Breast Cancer Awareness Month website, this is the 25th year of “celebrating awareness, education and empowerment.”  Yet despite the abundance of pink each October, many women are still confused about breast cancer screening and recent guideline changes. 

In 2009, the United States Preventative Services Task Force (USPSTF) came out with new guidelines for breast cancer screening that caused concern among many women and health care providers alike.  Among these, the most concerning for me is the recommendation that women no longer perform breast self-exams. 

The USPSTF states that breast self-exams do not reduce breast cancer mortality. According to the evidence, breast self-exams yield a high rate of false-positives, may increase patient anxiety and trigger unnecessary follow-up and procedures. 

Despite these guidelines, I continue to teach or discuss breast self-exams with every patient. I do not give them strict guidelines for how often to examine their breasts, but encourage them to know their bodies. It is an easy, no-cost tool that takes only a few minutes to explain during an annual exam, so why discourage women from doing it?

I stress to my patients that it's not about looking for cancer or doing the exam right, but knowing what their breasts normally feel like and the changes that can occur in breast tissue during the menstrual cycle. Evidence may not support this practice, but most of my patients with breast cancer initially found abnormalities while doing SBE, rather than in screening mammograms. 

For now, the American Cancer Society and the American College of Obstetricians and Gynecologists continue to support BSE, along with annual clinical breast exams and screening mammography for women aged 40 and older.  Women with genetic predisposition or other risk factors need more vigilant screening. It is important to keep in mind that as with many types of cancer, there is not one perfect diagnostic test for breast cancer. 

Hopefully in the near future, a universal method for early detection of breast cancer will become a reality.  Until then I will continue to educate my patients about breast self-exams, not just in October but everyday!

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